NGAL和KIM-1在重症监护室危重患者早期急性肾损伤中的诊断价值

目的探讨尿液、血清中性粒细胞明胶酶转运蛋白(NGAL)和尿肾损伤分子-1(KIM-1)在重症监护室(ICU)危重症患者急性肾损伤(AKI)中的早期诊断价值。方法选取2010年6月至2011年5月本院以各种原发病于ICU病房治疗,且继发AKI的危重症患者23例,同期于ICU治疗的非AKI患者24例和健康者21例,用定量酶联免疫吸附试验(ELISA)检测尿液、血清NGAL和尿KIM-1水平,用常规生化方法检测血清尿素氮(BUN)、肌酐(Cr),用乳胶增强免疫比浊法检测血清胱抑素C(Cys C)。健康对照组、AKI患者入院时,AKI患者组、ICU非AKI患者组组间比较采用两独立样本t检验;应用受试者操作特征曲线(ROC曲线)评价各指标对AKI的诊断价值。结果 AKI患者组血清NGAL、尿NGAL、尿KIM-1、BUN、Cr和Cys C水平显著高于健康对照组,差异有统计学意义(P<0.01);AKI患者组与其入院时各研究指标比较,血清NGAL、尿NGAL、尿KIM-1、BUN和Cr水平差异有统计学意义(P<0.01);AKI患者组与非AKI患者组间血清NGAL、尿NGAL、尿KIM-1和Cr水平差异有统计学意义(P<0.01);血清NGAL、尿液NGAL、尿液KIM-1、Cr、Cys C、BUN的ROC曲线下面积依次为1.00、0.97、1.00、0.98、0.98、0.99。结论 AKI患者组与其他各研究组间血清NGAL、尿NGAL、尿KIM-1水平差异有统计学意义,血清NGAL、尿NGAL、尿KIM-1作为新的肾损伤标志物,对AKI具有早期诊断价值。

Early diagnostic value of NGAL and KIM-1 in ICU patients with acute kidney injury

Objective To explore the early diagnostic significance of serum and urine neutrophil gelatinase associated lipocalin（NGAL）and urine kidney injury molecule-1（KIM-1）in ICU patients with acute kidney injury（AKI）.Methods A total of 23AKI patients and 24non-AKI patients,hospitalized in ICU of this hospital from Jun.2010to May.2011,and 21healthy subjects were enrolled and detected for serum and urine NGAL and KIM-1,and serum urea nitrogen（BUN）,creatinine（Cr）and cystatin C（Cys C）.All data were statistically analyzed.Results Serum levels of NGAL,BUN,Cr and Cys C,and urinary levels of NAGL and KIM in AKI group were higher than healthy group（P0.01）.The differences of serum levels of NGAL,BUN and Cr,and urinary levels of NGAL and KIM-1between detection before and after therapy were significant（P0.01）.The differences of serum levels of NGAL and Cr,and urinary levels of NGAL and KIM-1between AKI group and non-AKI group were significant（P 0.01）.Area under receiver operating characteristic curve of serum NGAL,urinary NGAL,urinary KIM-1,serum Cr,Cys C and BUN was 1.00,0.97,1.00,0.98,0.98and 0.99respectively.Conclusion The level of serum NGAL,urine NGAL and KIM-1could be increased significantly in AKI patients,which might be with early diagnostic value in AKI.